Making healthcare personal

The future of medical imaging

Some examples:
Bathroom fxtures with embedded devices that can detect potential problems, such as a
toilet that analyzes urine to identify kidney infections or the progression of chronic conditions
such as diabetes and hypertension. Another example is a bathroom scale that detects
sudden changes in weight or body fat. These devices could automatically upload data to
the patients physician and schedule appointments based on the physicians
predetermined criteria.
Connected diagnostic devices such as retinal scanners could be coupled with patients
existing consumer electroics products, such as digital cameras, to provide additional diagnostic
and treatment options and make information available to proper medical personnel.
Sensors in the home could measure how a person is walking to determine if he or she may
be a candidate for a medical episode, such as a seizure. This is another example of how
health care can be preventative and move deeper into the home without signifcant trade-
offs in quality of care.
An alarm clock that tells the person its waking that its scheduled a doctors appointment,
perhaps based on information collected from other health care devices around the home,
such as the retinal scanner embedded in the bathroom mirror. This example brings new
meaning to the term personal area network (PAN), where multiple devices throughout a
home regularly and noninvasively monitor and record a persons vital signs.
Equipment can be brought into the home and be remotely connected to a caregivers
network. One example of a product in development is a gyroscope-based device worn by
elderly patients to detect whether theyve fallen.
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This device could then connect to the
patients PAN to send for help. Near-falls, as well as extended sedentary periods (which
could be a sign of a developing physical or psychological problem) could also be documented
and reported to the patients physician.
Remote surgery, where a world-renowned specialist operates on a hologram thats used
to control a surgical robot thousands of miles away. This approach spreads the best care
around the world, allowing patients to be treated by world-renowned specialists without
requiring them to travel thousands of miles.
Mark Nadeski
Global director of marketing,
Medical Imaging Group
Texas Instruments
m-nadeski@ti.com
Gene Frantz
Principal fellow
Texas Instruments
genf@ti.com
W H I T E P A P E R
The 19th century poet Emily Dickinson was
reclusive to the point that she would allow a
doctor to examine her only from a distance of
several feet as she walked past an open door.
If she were alive today, its likely that she would
benet from advances in medical imaging that
could accommodate her standofshness while
still diagnosing the Brights disease that ended
her life at age 55.
One example of our technologically enabled
future is a bathroom mirror with a retinal
scanner behind the glass that looks for retinopathy
or collects vital signs. In the case of Dickinson,
that mirror could have noticed a gradual increase
in the pufness of her face, a symptom of Brights
disease, and alerted her physician.
This technology also could be a viable way
to improve care for patients who are too
busy to schedule routine doctor visits. For
Iatrophobics whose fear of doctors has them
putting off regular checkups advances in
medical imaging enable a wide variety of
noninvasive diagnostic options.
For health care providers and their
patients, these and other advances in medical
technology make health care increasingly personal
in terms of managing chronic diseases, predicting
catastrophic ones and enabling patients to live
out their nal months or years in the comfort of
their homes. These advances also allow health
care to become a routine part of daily life.
The future of medical imaging November 2008
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Virtual house calls, where physicians use videoconferencing a service that many telecom operators plan
to offer for the consumer market and home-based diagnostic equipment such as portable ultrasound
systems. Virtual house calls may be particularly attractive to patients in rural areas
2
or those in major cities
with chronic traffc jams. Virtual house calls are also a way to bring health care to patients who otherwise
wouldnt be able to see a physician, perhaps because theyre bedridden, suffering from latrophobia or have
limited means of transportation. Whatever the hurdle, virtual house calls are yet another example of how
advances in medical technology are increasingly bringing care to the patient, instead of the other
way around.
All of these examples improve patient care by making it a round-the-clock service rather than something
that occurs infrequently and requires a disruption of daily routines. They enable earlier identifcation of health
problems before a condition becomes irreversible. As a result, patients may receive care thats more
thorough than if they had to fnd time for an offce visit every week or month.
Automatic monitoring also eliminates the need for patients to remember to record information. As health care
becomes a round-the-clock service, the cost of delivering care is reduced by automating processes.
For some patients, these technologies can enable care that they otherwise wouldnt receive for reasons such
as fnances or distance. A prime example is Dr. Devi Prasad Shetty, a cardiologist who has combined digital
X-rays with satellite broadband to bring health care to residents of Indias remote, rural villages.
3
Shettys
telemedicine program has had a major impact in India, where an average of four people have a heart attack
every minute,
4
by bringing cardiac care to people who otherwise wouldnt receive it simply because of where
they live.
Medical imaging is continually evolving and advancing, all with the goal of improving patient care. Here are
some examples.
The migration of X-rays from lm to digital les. In India, this migration has revolutionized health care
by streamlining the process to the point that one of Dr. Shettys clinics now handles 3,000 X-rays every
24 hours. Through the use of digital signal processing (DSP), X-ray signals now can be converted to digital
images at the point of acquisition, with no trade-offs in image clarity. Digital fles have a variety of benefts,
including eliminating the time and cost of processing flm, as well as more reliable storage. The ability to
render digital images in real time has led to the use of digital X-ray machines in surgical procedures,
allowing doctors to view a precise image at the exact time of surgery.
Advances in
medical imaging
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The evolution of MRIs from slow and fuzzy to fast and highly detailed. Todays magnetic resonance
imagers (MRIs) can provide higher quality images in a fraction of the time that it took machines that were
state-of-the-art just a few years ago. Todays MRIs are also highly fexible, with the ability to take images
of the spine while its in a natural, weight-bearing, standing position.
Todays MRIs are also enabling tomorrows breakthroughs. For example, with diffusion MRIs, researchers can
create brain maps to study the relationships between disparate brain regions via tractography. Functional
MRIs, meanwhile, rapidly scan the brain to measure signal changes caused by changing neural activity.
These highly detailed images provide researchers with deeper insights into how the brain works insights
that can improve treatment.
The portability of ultrasound. Over the past several years, ultrasound equipment has become more compact,
with cart-based systems increasingly complemented or replaced by portable and handheld ultrasound
machines. This reduction in size is enabling a wide variety of health care applications that illustrate how
advances in medical technology are bringing care to patients instead of forcing them to travel. Portable
and handheld ultrasound systems are also instrumental in bringing health care to rural and remote areas,
disaster sites, patient rooms in hospitals, assisted-living facilities and even ambulances.
Retinal implants become reality. Researchers at the University of Southern Californias Doheny Eye
Institute
5
are refning artifcial retina technology that could restore some vision for patients with retinitis
pigmentosa and macular degeneration.
A common theme fows through all of these examples: the use of digital signal processing. DSPs are used
in multiple application areas that affect the world of medicine and our lives every day. More importantly, the
technology is still in the early stages of its impact on medicine and health.
Advances in medical imaging are frequently complemented by advances in communications networks.
Together, they have signifcantly improved patient care while also reducing costs for health care providers
and insurance companies.
One example is NightHawk Radiology Services.
6
Instead of maintaining a full radiological staff overnight, a
hospital emergency room can send an X-ray via broadband Internet link to NightHawk facilities in Sydney,
Australia, or Zurich, Switzerland. NightHawks staff then reads the X-ray and returns a diagnosis to the
ER doctors.
How telecom
complements
medical imaging
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4 Texas Instruments
Telemedicine is another example of how medical imaging and telecom technologies complement each other.
Videoconferencing and a new, immersive version called telepresence
7
are increasingly used in both developed
and developing countries for health care. Videoconferencing and telepresence systems are often paired with
medical imaging systems such as ultrasound machines to enable telemedicine applications, which often enjoy
government subsidies simply because they bring health care to areas where its expensive, scarce or both.
The Missouri Telehealth Network
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services include teledermatology, where a patient at a rural health clinic
can put his scalp under a video camera for viewing and diagnosis by a dermatologist hundreds of miles away,
providing a videoconference that mimics a face-to-face meeting. If the patient has limited time or transportation
options, telemedicine could mean the difference between treatment and suffering. In the case of someone with
stage 1 melanoma, early detection through telemedicine could mean the difference between life and death.
DSPs play a key role in telemedicine. For example, DSPs provide the processing power and fexibility necessary
for videoconferencing and telepresence systems to support a variety of codecs. Some of these codecs
compress video to the point that a TV-quality image can be transported across low-bandwidth wired or
wireless networks. This ability extends telemedicine to remote, rural areas and developing countries where
telecom infrastructure has limited bandwidth. In the future, compression will also help extend telemedicine
to patients homes over cable and DSL connections.
DSPs also provide the processing power necessary to support the lossless codecs required for medical imaging,
where little or no compression could impact image quality and affect the diagnosis. The programmability
of DSPs allows them to be upgraded in the feld to support new codecs as they become available, thereby
providing a degree of futureproofng for end users such as hospitals and physicians groups.
As impressive as some of the aforementioned advances might sound, theres ample research underway that
likely will improve health care even further over the next decade.
For example, CNOGA
9
is an Israeli company whose technology uses video cameras to noninvasively measure
vital signs such as blood pressure, pulse rate, and blood oxygen and carbon dioxide levels simply by focusing
on the persons skin. Future applications of this technology can lead to noninvasively identifying biomarkers
for diseases such as cancer and chronic obstructive pulmonary disease.
The future of
health care
The future of medical imaging November 2008
5 Texas Instruments
As medical imaging advances, it becomes increasingly possible to conduct more tests in the patients home.
This benefts insurance companies by reducing the amount paid for offce visits, while patients beneft by
having to schedule less time for offce visits and not enduring the inconvenience of seeing a doctor. For those
with transportation issues or infexible work schedules, telemedicine can help identify and treat conditions
before they become debilitating or life-threatening.
Other research includes:
Single-chip ultrasound. Shrinking an octal ultrasound receiver down to a single chip enables portable
designs, but has historically also required a trade-off in image quality, which limited the units usefulness
as a diagnostic tool. However, recent advances in integration have minimized that trade-off by reducing the
signal paths size, as well as noise levels. The goal is to create a single-chip design that allows the probe,
receive, transmit and processing chains to be integrated. That in turn allows all of the ultrasound machine
electronics to reside in the probe head, which then can use a wireless link to transmit information to the
display. Single-chip designs also complement 3-D probes, which have signifcantly more transducer
elements and thus require more cabling to the machine.
High-intensity focused ultrasound (HIFU). This technology is part of a trend in health care toward reducing
the impact of procedures in terms of incision size, recovery time, hospital stays and infection risk. But
unlike many other parts of this trend, such as robot-assisted surgery, HIFU goes a step further to enable a
noninvasive option for many procedures currently done invasively.
One example is using transrectal ultrasound
10
to destroy prostate cancer cells without damaging the healthy,
surrounding tissue. HIFU can also be used to cauterize bleeding and melt fat, so its a potential ft for a wide
variety of procedures, including cosmetic ones.
Beyond MRIs. Researchers at the University of Missouri
11
are using 3-D images rather than MRI slices to
identify correlations between childrens facial features and brain structures. Those correlations may allow
physicians to diagnose autism earlier, as well as provide genetic insights to help future research into
the disorder.
This research dovetails with at least two trends in health care: a preference for noninvasive diagnostics and
the quest for early diagnosis. The latter is particularly important because the sooner autism is diagnosed, the
sooner parents and physicians can begin treatment and therapy.
With all of the technological advances in health care technology, its easy to forget what theyre really all
about: the patient. But whether its a retinal scanner in a bathroom mirror or a home ultrasound machine, its
the patient who is the greatest benefciary.
For latrophobics such as Emily Dickinson, new, noninvasive techniques that are increasingly available in the
comfort of ones home can make all the difference in diagnosing and treating diseases before they become
debilitating or life-threatening.
These advances enable health care to become more personal and, for lack of a better term, user-friendly,
with patients interacting with physicians through videoconferences from their homes or nearby clinics. They
also help make health care more effective by providing ways to identify diseases and other conditions before
they become untreatable.
At the same time, these advances also allow health care to fade into the background and become a part of
daily life: being scanned each morning while brushing ones teeth instead of only during an annual checkup.
Thats particularly valuable for patients with chronic or end-stage diseases because it may keep them from
having to move into a hospice. In that sense, health care revolves around the patient, as it should.
Someday soon, technology will be able to manage our chronic diseases, predict our catastrophic diseases
and allow us to live out the last days of our lives comfortably.
Conclusion: toward
more personal,
effective health care
6 Texas Instruments
B010208
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2008 Texas Instruments Incorporated SLYY020
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1
http://ieeexplore.ieee.org/xpl/freeabs_all.jsp?tp=&arnumber=1019448&isnumber=21925
2
www.columbiamissourian.com/stories/2007/05/12/improving-care-rural-diabetics
3
www.nancialexpress.com/news/everyone-must-have-access-to-healthcare-facilities-Devi-Prasad-Shetty/42099/
4
www.abc.net.au/foreign/stories/s785987.htm
5
www.usc.edu/uscnews/stories/13442.html
6
www.nighthawkrad.net
7
www.telepresenceworld.com/ind-medical.php
8
www.proavmagazine.com/industry-news.asp?sectionID=0&articleID=596571
9
www.cnoga.com
10
www.prostate-cancer.org/education/novelthr/Chinn_TransrectalHIFU.html
11
http://munews.missouri.edu/news-releases/2008/0818-duan-autism-research.php